title: TB treatment in a chronic complex emergency: treatment outcomes and experiences in Somalia.
abstract: BACKGROUND
  Médecins Sans Frontières (MSF) provides TB treatment in Galkayo and Marere in Somalia. MSF international supervisory staff withdrew in 2008 owing to insecurity but maintained daily communication with Somali staff. In this paper, we aimed to assess the feasibility of treating TB in a complex emergency setting and describe the programme adaptations implemented to facilitate acceptable treatment outcomes.
  
  
  METHODS
  Routinely collected treatment data from 2005-2012 were retrospectively analysed. In multivariate analyses, factors associated with successful outcome (cure or completion versus failure, death and default) were assessed, including the presence of international supervisory staff. Informal interviews were conducted with Somali staff regarding programmatic factors affecting patient management and perceived reasons for default.
  
  
  RESULTS
  In total, 6167 patients were admitted (34.8% female; median age 24.0 years [IQR 13.0-38.0 years]). Treatment success was 79% (programme range 69-87%). Presence of international staff did not improve outcomes (adjusted OR 0.85, 95% CI 0.66-1.09; p=0.27). Perceived reasons for default included being away from family, nomadic group, insecurity, travel cost, need to return to grazing land or feeling better.
  
  
  CONCLUSIONS
  Despite the challenges, a high percentage of patients were successfully treated. Treatment outcomes were not adversely affected by withdrawal of international supervisory staff.
authors.affiliation: Médecins Sans Frontières (MSF), Amsterdam, The Netherlands.
authors.forename: Karin Fischer
authors.initials: KF
authors.lastname: Liddle
authors.forename: Riekje
authors.initials: R
authors.lastname: Elema
authors.forename: Sein Sein
authors.initials: SS
authors.lastname: Thi
authors.forename: Jane
authors.initials: J
authors.lastname: Greig
authors.forename: Sarah
authors.initials: S
authors.lastname: Venis
mesh_terms: D000293:Adolescent; D000328:Adult; D000533:Altruism; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003220:Conflict, Psychological; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007390:International Agencies; D008297:Male; D008493:Medical Missions / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D012998:Somalia / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Complex emergency; Conflict; Humanitarian; Somalia; Tuberculosis